As soon as I found out I was pregnant with my son four years ago, I hired a doula. A good friend had worked with this woman, and loved her, and so I handed over $1,000 for her services (the going rate).
It seemed expensive for what it bought: four introductory sessions, a full accompaniment during the baby’s birth and one postpartum meeting. But I reasoned that we had no other medical expenses (I live in Montreal and birth is completely covered by our national healthcare system). And like so many women, I was somewhat terrified of giving birth, and I considered the doula an investment. Someone who could support me and my husband as we faced the great unknown of the delivery room, someone who could keep a cool head if things got heavy. As luck would have it, things were about to get very, very heavy. (Caution: If you are a pregnant woman hoping for an uncomplicated natural birth, stop reading now.)
After laboring at home for as long as possible, I went in to the hospital, as my doula had advised, all charged up to let nature take its course -- only get stuck in a painful limbo for the next three days, pumped full of everything from morphine to an epidural to intravenous antibiotics to what seemed like gallons of Pitocin. I watched the same handful of crabby nurses in pastel scrubs cycle through and the drab gray-blue walls of the labor room close in on me. The fetal monitoring band, a brown, frayed strap like a seat belt, was a vise grip that left welts on my bulging belly from being left on for so long. Tubes began sprouting from my body in all directions, like in some maudlin Frieda Kahlo painting – a urinary catheter from between my thighs, the epidural from my spine and the IV antibiotic conduit from my forearm.
My uterus was on the brink of rupturing after I developed a Bandl’s ring, an extremely rare complication that can result from prolonged labor and that spells certain death for mothers and babies without access to the kind of acute care most of us take for granted. At that point, I was rushed into a lifesaving (for both me and my baby) emergency C-section.
So, was my doula there, wiping my brow and holding my hand through these excruciating days, through the waves of soul-shattering pain, the spikes of panic and dread? Did this experienced mother-warrior guide me through the birthing battlefield as everything I thought couldn’t go wrong actually did? No. She'd triple-booked and was stuck at not one, but two other births. She had apparently taken on a trio of clients with due dates close enough to intersect, and I was the unlucky third in line.
I had no idea this could happen, and why would I? I’d bought into the effusive media coverage, which portrays a doula as both a pregnant woman’s fairy godmother and an essential part of a shiny, happy, 21st-century birthing experience. Celebrity moms from Nicole Kidman to Kelly Ripa endorse them. Erykah Badu became one. Parenting site Babble.com trumpeted “10 Reasons Why You Should Hire a Doula,” and earlier this year British newspaper The Telegraph declared doulas “the new must-have accessory for mums to be." Studies show their presence at hospital births can do everything from increase birthing mothers’ satisfaction to reduce the rate of C-sections, and an article on Salon recently argued that doulas could even save Medicaid millions of dollars.
But for me, the doula experience felt like a con and a rip-off.
My pregnancy began healthy and happy. I was an unquestioning champion of natural childbirth, dutifully buying the books my doula suggested reading, from “Birthing from Within,” with its earnest rhapsodizing about the power of making “birth art” (mostly drawings of groovy spirals and clay figurines with swollen breasts and bellies), to “An Easier Childbirth: A Mother’s Guide to Birthing Normally” (the not-so-subtle implication: natural birth = normal, good. Drugs and such = abnormal, bad). The doula I hired was a mother of four, with her own doula-training business and nearly two decades of attending births under her belt. I assumed I’d be in the best possible hands since I was planning to give birth in a hospital, but hoping to avoid all the “bad” stuff. I’d heard that this doula was a great mediator between birthing couples and overzealous medical staff. I trusted her when she assured me that unless her own children were sick, she would be there at my birth.
Coincidentally, I had met one of the two women at whose birthings my doula would attend instead. We were at a party in our seventh month of pregnancy. “Oh, you’re seven months pregnant? Meet so-and-so. She’s seven months pregnant too.” So the two of us made the usual preggie small talk: When’s your due date? How do you plan on doing it? Turns out we not only had the exact same due date – we had the exact same doula. This did not make her happy: “What the hell?” she asked. “What if we go into labor at the same time? Who does she go to first?”
But I was still in my positive-vibes, visualize-the-perfect-birth mode, and so I didn’t bat an eye. Didn’t she know only a tiny fraction of babies actually arrive “on time” like some traceable express-post package? Besides, I knew my birth would be smooth sailing and rainbows and unicorns with my doula holding my hand. Uh huh, because that’s what the natural childbirth books said: If you build the labor of your dreams in in your mind, it will come to you.
Mine did not. By the second day of labor, while painfully ensnared by this supposedly completely natural physical process gone haywire, after much texting back and forth, I got the replacement doula: a chipper woman in her mid-twenties, who’d attended a handful of births and had never had a child of her own. She was sweet and did a lot of rueful “I'm here for you” smiling and hand squeezing. And to her credit, she was a comfort to my husband when he felt like he was watching me get repeatedly run over by a truck, in slow motion. But this young doula, whom I had barely met before laboring, was not the doula I knew and was promised. That was my first doula disappointment. My second came a few weeks later.
After the birth, I needed help getting in and out of bed. Because of all the IV fluids, my lower legs had swollen to twice their usual size. I was weepy and kept having flashbacks of the labor, especially the frenzied moments before they rushed me into the operating room. While pregnant I’d lined up the help of a postpartum doula through my birth doula’s company, paid in advance for 10 hours of postpartum doula services at $35 per hour. That seemed steep in comparison to the average sitter or nanny's hourly rate, but I assumed a postpartum doula would offer more specialized help.
Instead, her services seemed to consist of sitting on my couch and chatting about her son's Waldorf school while I breastfed, then heating up a tofu stir-fry she'd made for the occasion. After emerging from my first year of baby brain fog, I realized that she never did complete the 10 hours work I pre-paid her for – she only came for eight. I finally emailed the postpartum doula, saying that I knew a fair bit of time had passed, but could she kindly reimburse me for the two unworked hours, as a matter of principle. She said there’d been a baby boom of late and that she’d have to get back to me about my request. A week went by and I didn’t hear from her. At this point I was pissed with the whole Namaste attitude that accompanied her evasiveness. How many other overwhelmed, completely out-of-it new moms were prepaying for this kind of “support,” not keeping track and then not getting what they paid for? When I finally told her that if she did not reimburse me I would contact the big boss doula, she swiftly emailed back to say she’d be dropping a check in the mail and wished me “love and healing.”
When you read natural birth advocates, online and in books, railing against the patriarchal, paternalistic medical establishment that robs birthing mothers of our right to a natural childbirth, you’d think all obstetricians are scalpel-wielding, drug-pushing maniacs hell-bent on overriding our wishes. But what about those of us who’ve felt screwed over, not by some Type A surgeon (one of those saved my life and my son’s), but by our own sisters, our supposed protector-companions and the champions of our rights? At least the hospital has an ombudsman.
I’ve read a number of posts on message boards and blogs by other moms complaining about toxic, unethical and no-show doulas – where else can we take our grievances but the Internet? A close friend of mine soured on her doula too. “She positioned herself as a spiritual guru, but in reality she was a self-centered flake,” this friend vented recently. “When I told her I had carpal tunnel, she told me I didn’t. Based on what? I have no idea. All she talked about was herself.” The doula announced at their very first meeting – after signing a contract and taking a deposit – that she would be on vacation at the time of my friend’s due date. She then suggested that my friend try to get induced – “naturally, of course” – by visiting an acupuncturist or osteopath if she hadn’t gone into labor before her vacation. “It was all about her,” my friend fumed. “I was supposed to make my birth fit her schedule.”
The great majority of doulas must do great work. Otherwise why would so many women speak so highly of them? I truly hope that my friend and I and our fellow pissed moms on the message boards are the exception to the rule. I really hope that most women who hire doulas get the support they need. But doula certification, as with yoga teachers and life coaches, varies widely and is completely unregulated. Parents should spend the same amount of time researching and vetting potential doulas as they do their non-toxic crib mattress, ergonomic baby sling or doctor.
In the end, doulas are only human. Not perfect Mary Poppins creations, but a collection of fallible, sometimes misguided women trying to make a living in the burgeoning but murky pregnancy and birth companion industry. I’m not blaming anyone for my awful birthing experience. Maybe I was expecting too much from doulas. Maybe I’m guilty of magical thinking – expecting doulas to be some kind of insurance against things going wrong. When you’re pregnant for the first time, you have no idea what awaits you one the other side and you feel less in control than you’ve ever felt in your whole life, and it’s hard not to grasp for whatever talisman you can find – be it a home water birth or elective C-section. But now, when I read a headline like, “Doulas: The Answer to Every Pregnant Woman’s Dreams (And Then Some),” I know to take it with a shaker of salt. No one can be the answer to every pregnant woman’s dreams. Not even Erykah Badu -- though I bet she comes close.